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Chen X, Alhaskawi A, Wu Y, Lu H. Efficacy analysis of minimally invasive surgery of distal radius fractures in a series of 30 patients. Asian J Surg 2024:S1015-9584(24)00710-3. [PMID: 38653700 DOI: 10.1016/j.asjsur.2024.04.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/12/2024] [Indexed: 04/25/2024] Open
Affiliation(s)
- Xiaowei Chen
- Department of Orthopedics, Jingning Shezu Autonomous County People's Hospital, Renmin North Road, Lishui, Zhejiang, 310003, China.
| | - Ahmad Alhaskawi
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University, #79 Qingchun Road, Hangzhou, Zhejiang Province, 310003, China.
| | - Yu Wu
- Department of Orthopedics, Jingning Shezu Autonomous County People's Hospital, No. 8 Fenghuang Avenue, Hexi Town, Jingning County, China.
| | - Hui Lu
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University, #79 Qingchun Road, Hangzhou, Zhejiang Province, 310003, China.
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Huang CY, Lee CC, Chen CW, Hu MH, Wu KW, Wang TM, Wang JH, Tseng TH. The Outcome of under 10 mm Single-Incision Surgery Using a Non-Specialized Volar Plate in Distal Radius Fractures: A Retrospective Comparative Study. J Clin Med 2023; 12:7670. [PMID: 38137740 PMCID: PMC10743621 DOI: 10.3390/jcm12247670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/06/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND The distal radius fracture is a common orthopedic injury. We aimed to share the surgical steps and investigate the outcomes of treating distal radius fractures with wounds ≤10 mm using a globally accessible locking plate. METHODS We collected 46 patients who underwent surgery via a <10 mm wound, with a control group consisting of 40 patients who underwent conventional procedures. Both groups were treated using the same volar plate. We compared the radiographic reduction quality, including volar tilt angle, radial inclination angle, and ulna variance. Additionally, clinical outcomes, such as pain assessed using VAS, Q-Dash score, and PRWE, were evaluated. Patient satisfaction with the wound was also analyzed. The follow-up time for the clinical outcomes was 24.2 ± 13.47 months. RESULTS There were no differences in the quality of reduction in parameters such as the volar tilt angle (p = 0.762), radial inclination angle (p = 0.986), and ulna variance (p = 0.166). Both groups exhibited comparable results in pain VAS (p = 0.684), Q-Dash score (p = 0.08), and PRWE (p = 0.134). The ≤10 mm incision group displayed an increase in satisfaction with the wound (p < 0.001). CONCLUSIONS Treating distal radius fractures with a <10 mm wound using a non-specialized locking plate is a feasible approach. It does not compromise the quality of fracture reduction or functional scores and improves wound satisfaction.
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Affiliation(s)
- Chang-Yu Huang
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei City 100225, Taiwan
- Department of Orthopaedic Surgery, En Chu Kong Hospital, New Taipei City 237, Taiwan
| | - Chia-Che Lee
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei City 100225, Taiwan
| | - Chih-Wei Chen
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei City 100225, Taiwan
| | - Ming-Hsiao Hu
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei City 100225, Taiwan
| | - Kuan-Wen Wu
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei City 100225, Taiwan
| | - Ting-Ming Wang
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei City 100225, Taiwan
| | - Jyh-Horng Wang
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei City 100225, Taiwan
| | - Tzu-Hao Tseng
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei City 100225, Taiwan
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Liverneaux P, Amiri LE, Facca S, Sapa MC. Technique, Indications and Limitations of a Minimally Invasive Approach to Treat Distal Radius Fractures and Malunions. HANDCHIR MIKROCHIR P 2023. [PMID: 36716774 DOI: 10.1055/a-1951-1585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The minimally invasive flexor carpi radialis approach can be used for volar locking plate fixation of distal radius fractures. It offers the advantage of preserving ligamentotaxis, which facilitates the reduction and the small size of the scar improves the esthetic result of the procedure. It is indicated for extra-articular fractures of the distal radius. In the case of an intra-articular fracture, an arthroscopy may be associated. In the case of a proximal diaphyseal extension of the fracture, a second proximal approach can be added in order to use a longer plate. Relative contraindications are comminuted articular fractures in elderly osteoporotic patients. Functional and radiological results are comparable to those obtained with the extented flexor carpi radialis approach. A conversion of the procedure for a larger incision is always possible in the case of a difficult reduction.
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Affiliation(s)
- Philippe Liverneaux
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, avenue Molière, Strasbourg, France.,ICube CNRS UMR7357, Strasbourg University, rue Boussingault, Strasbourg, France
| | - Laela El Amiri
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, avenue Molière, Strasbourg, France
| | - Sybille Facca
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, avenue Molière, Strasbourg, France.,ICube CNRS UMR7357, Strasbourg University, rue Boussingault, Strasbourg, France
| | - Marie-Cécile Sapa
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, avenue Molière, Strasbourg, France
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Ducournau F, El Amiri L, Vernet P, Sapa MC, Liverneaux P. Methods of assessment of the level of surgeons for minimally invasive fixation of distal radius fractures: "expertise" versus "performance". INTERNATIONAL ORTHOPAEDICS 2023; 47:193-199. [PMID: 36264303 DOI: 10.1007/s00264-022-05609-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The results of surgical techniques vary depending on the level of the surgeon's experience. The level of expertise can be evaluated quantitatively or qualitatively. In this study, we evaluated the duration of the procedure and the size of the incision of minimally invasive fixation of distal radius fractures as a means of grading expertise and surgical performance. The null hypothesis of our study was that the level of expertise did not match the level of performance. MATERIAL AND METHODS The study included 52 surgeons split in five levels of expertise who had performed 467 minimally invasive fixations of distal radius fractures. The performance of the surgeons in terms of duration of the procedure and size of the incision were scored according to the five levels of surgical experience using four different methodologies: clinical (setting limits compared to data found in literature), statistical (setting statistical limits of comparison in percentiles (20th, 40th, 60th, 80th) for each of the two parameters measured), arithmetical (setting limits compared to equal intervals for each of the 2 variables), and success rate (setting a threshold for each of the 2 variables). RESULTS Our results showed a great disparity between levels of experience depending on the method used. The scores for levels 1 and 2 were 72% for expertise, 13% for performance according to the clinical method, 75% for the statistical method, 0% for the arithmetical method, and 57% according the success rate. The rate of level 3 was 23% for expertise, 41% for performance by the clinical method, 17% by the statistical method, 17% by the arithmetical method, and 15% by the success rate. The rates of levels 4 and 5 were 5% for expertise, 46% for performance clinical method, 8% by the statistical method, 83% by the arithmetical method, and 28% by the success rate. DISCUSSION The null hypothesis of our study was confirmed by the results which show that there was no correlation between levels of expertise and performance. The clinical method of assessment appears to reflect best the true level of performance of the surgeon. CONCLUSION Publications reporting the results of a surgical technique for a given pathology should always mention the level of performance as measured on a clinical scale.
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Affiliation(s)
- François Ducournau
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 avenue Molière, 67200, Strasbourg, France
| | - Laela El Amiri
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 avenue Molière, 67200, Strasbourg, France
| | - Paul Vernet
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 avenue Molière, 67200, Strasbourg, France
| | - Marie-Cécile Sapa
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 avenue Molière, 67200, Strasbourg, France
| | - Philippe Liverneaux
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 avenue Molière, 67200, Strasbourg, France.
- ICube CNRS, UMR7357, Strasbourg University, 2-4 rue Boussingault, 67000, Strasbourg, France.
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Pääkkönen M. Mini-invasive Osteotomy for Pediatric Distal Radius Malunion. Tech Hand Up Extrem Surg 2022; 26:89-92. [PMID: 34293754 DOI: 10.1097/bth.0000000000000362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although most malunions after pediatric distal radius fractures will remodel as the child grows, adolescent patients with severe malunion and limited growth require reduction to restore alignment. The authors technique for a mini-invasive osteotomy is presented. The apex of the malunion is approached from a single 2 cm volar incision through the flexor carpi radialis sheath. Open wedge osteotomy is performed. The osteosynthesis is secured with an individually contoured T-plate. The procedure was used to correct a severe visible malunion in a 12-year-old girl. Normal alignment was achieved with no nerve or tendon injury or irritation, infection, refracture, or any other complication. Mini-invasive osteotomy with a volar plate is a feasible method for experienced hand surgeons for the treatment of distal radius malunion in adolescents.
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Affiliation(s)
- Markus Pääkkönen
- Department of Hand Surgery, Turku University Hospital, University of Turku and CoE TYKS ORTO, Turku, Finland
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Van Oijen GW, Van Lieshout EMM, Reijnders MRL, Appalsamy A, Hagenaars T, Verhofstad MHJ. Treatment options in extra-articular distal radius fractures: a systematic review and meta-analysis. Eur J Trauma Emerg Surg 2022; 48:4333-4348. [PMID: 34009418 PMCID: PMC9712287 DOI: 10.1007/s00068-021-01679-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 04/19/2021] [Indexed: 01/11/2023]
Abstract
PURPOSE This systematic literature review aimed to make a detailed overview on the clinical and functional outcomes and to get insight into the possible superiority of a treatment method for extra-articular distal radius fractures. METHODS Embase, Medline, Cochrane Library, Web of Science, and Google Scholar were searched for studies describing treatment results. Five treatment modalities were compared: plaster cast immobilization, K-wire fixation, volar plating, external fixation, and intramedullary fixation. RESULTS Out of 7,054 screened studies, 109 were included in the analysis. Overall complication rate ranged from 9% after plaster cast treatment to 18.5% after K-wire fixation. For radiographic outcomes, only volar tilt in the plaster cast group was lower than in the other groups. Apart from better grip strength after volar plating, no clear functional differences were found across treatment groups. CONCLUSION Current literature does not provide uniform evidence to prove superiority of a particular treatment method when looking at complications, re-interventions, and long-term functional outcomes.
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Affiliation(s)
- Guido W. Van Oijen
- grid.5645.2000000040459992XTrauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Esther M. M. Van Lieshout
- grid.5645.2000000040459992XTrauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Maarten R. L. Reijnders
- grid.5645.2000000040459992XTrauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Anand Appalsamy
- grid.5645.2000000040459992XTrauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Tjebbe Hagenaars
- grid.5645.2000000040459992XTrauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Michael H. J. Verhofstad
- grid.5645.2000000040459992XTrauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
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Vernet P, Gouzou S, Hidalgo Diaz JJ, Facca S, Liverneaux P. Minimally invasive anterior plate osteosynthesis of the distal radius: A 710 case-series. Orthop Traumatol Surg Res 2020; 106:1619-1625. [PMID: 33153957 DOI: 10.1016/j.otsr.2020.04.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/04/2020] [Accepted: 04/21/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Since the 2000s, internal fixation of distal radius fracture by volar locking plate on an extended flexor carpi radialis (FCR) approach has become the gold standard. OBJECTIVE The present study aimed to assess medium-term results of minimally invasive plate osteosynthesis (MIPO) in distal radius fracture. MATERIAL AND METHODS The series comprised of 710 cases (512 female; mean age, 58 years). The 15mm approach was on the lateral edge of the FCR. The plate was slipped under the pronator quadratus. Closure used intradermal running suture without drain or orthosis. RESULTS At a mean 7 months' follow-up, mean scar length was 17mm (range, 10-40mm), pain 1.13/10 (0-8), Quick-DASH 13.28 (0-86.36), and patient-rated wrist evaluation (PRWE) 11.48 (0-91). Compared to contralateral values, mean flexion was 87.23%, extension 88.52%, pronation 96.17%, supination 93.41%, and grip strength 79.68%. Hardware was removed in 45.92% of cases. There were 16 cases of secondary displacement, with 4 revision procedures, one of sepsis at 6 months, 10 of complex regional pain syndrome, and 14 of median nerve paresthesia, with 4 carpal tunnel release procedures. DISCUSSION The minimally invasive FCR approach can be used for volar plate fixation of distal radial fracture. It has the advantage of conserving ligamentotaxis, facilitating reduction and improving scar esthetics. The incision can be extended if need be. LEVEL OF EVIDENCE III; single-centre retrospective study.
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Affiliation(s)
- Paul Vernet
- Department of hand surgery, SOS Hand, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 1, avenue Molière, 67000 Strasbourg, France
| | - Stéphanie Gouzou
- Department of hand surgery, SOS Hand, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 1, avenue Molière, 67000 Strasbourg, France
| | - Juan José Hidalgo Diaz
- Department of hand surgery, SOS Hand, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 1, avenue Molière, 67000 Strasbourg, France
| | - Sybille Facca
- Department of hand surgery, SOS Hand, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 1, avenue Molière, 67000 Strasbourg, France
| | - Philippe Liverneaux
- Department of hand surgery, SOS Hand, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 1, avenue Molière, 67000 Strasbourg, France.
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Fan J, Zhang X, Ji JQ, Yao Y, Li SZ, Yuan F, Cheng LM. Fixation of distal radius fracture with volar locking palmar plates while preserving pronator quadratus through the minimally invasive approach. Technol Health Care 2020; 29:167-174. [PMID: 32538887 DOI: 10.3233/thc-192113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The volar locking plate technique with an L-shaped incision of the PQ muscle through the classic volar Henry approach is a popular method for treating distal radius fractures. Recently we revised and improved this traditional technique by performing mini-invasive surgery. OBJECTIVE The purpose of this study was to evaluate the clinical effects after fixation of distal radius fracture with volar locking palmar plates while preserving the pronator quadratus through minimally invasive approach. METHODS From May 2014 to March 2017, 58 patients (38 males and 21 females) with an age range of 22-72 years (mean age 44.6 years) and with distal radius fractures underwent open reduction and internal fixation with volar locking palmar plates. The patients were classified as 23A-2 through 23C-2 according to the Orthopedic Trauma Association fracture classification system. All surgeries were completed by one trained team. The group that received volar locking palmar plates of distal radius performed with the traditional method through Henry approach involved 33 patients (21 males and 12 females) and the group that received PQ through minimally invasive approach group involved 25 patients (16 males and 9 females). We compared the two groups for wrist pain, forearm range of motion, grip strength, preoperative complications and wrist functional recovery score. RESULTS The minimum follow-up for the whole cohort was one year. The differences between the two groups were significant in terms of wrist pain, forearm range of motion, grip strength and wrist function at 1, 2, 6 weeks postoperatively, but insignificant at 3 and 12 months postoperatively. In the minimally invasive group a case of limited extension of the forefinger 3 months postoperatively was found. No significant differences were found for preoperative complications and radiographs postoperatively. CONCLUSION Fixation with volar locking palmar plates through minimally invasive approach is a satisfactory and optional method in the treatment of distal radius fractures. This technique yields better early wrist function, shortens rehabilitation time and gets high psychological satisfaction.
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Affiliation(s)
- Jian Fan
- Department of Orthopedics, Tongji Hospital, Tongji University, Shanghai, China.,Department of Orthopedics, Tongji Hospital, Tongji University, Shanghai, China
| | - Xin Zhang
- Department of Orthopedics, Jiading District Central Hospital, Shanghai University of Medicine and Health Sciences, Shanghai, China.,Department of Orthopedics, Tongji Hospital, Tongji University, Shanghai, China
| | - Jia-Qing Ji
- Department of Orthopedics, Tongji Hospital, Tongji University, Shanghai, China
| | - Ying Yao
- Department of Orthopedics, Tongji Hospital, Tongji University, Shanghai, China
| | - Shan-Zhu Li
- Department of Orthopedics, Tongji Hospital, Tongji University, Shanghai, China
| | - Feng Yuan
- Department of Orthopedics, Tongji Hospital, Tongji University, Shanghai, China
| | - Li-Ming Cheng
- Department of Orthopedics, Tongji Hospital, Tongji University, Shanghai, China
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Siow BRS, Tong CRH, Satku M, Sechachalam S, Yeo CJ. Transverse or longitudinal? A survey of volar wrist incision preferences. Singapore Med J 2019; 61:548-550. [PMID: 31535152 DOI: 10.11622/smedj.2020023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION In volar wrist surgery, the traditional longitudinal incision leaves a scar that may be considered cosmetically unpleasant. Recent studies suggest that transverse wrist incisions result in more aesthetically pleasing scars that are well hidden in the wrist crease. The aim of our study was to explore the public's perceptions of longitudinal versus transverse wrist scars. METHODS A prospective survey was conducted among the general public. Inclusion criteria were patients aged over 18 years with no prior surgery to the wrist. Survey questions assessed included: (a) longitudinal or transverse scar preference; (b) reasons for preference; and (c) demographic information. RESULTS There were 107 respondents from the general public. More respondents preferred longitudinal scars. Top three reasons for longitudinal scar preference were: (a) perceived damage to wrist structures by a transverse incision; (b) better cosmesis; and (c) scar from the transverse incision appearing like a self-inflicted injury. Top three reasons for transverse scar preference were: (a) easily concealed by accessories; (b) less noticeable; and (c) better cosmesis. Respondents aged 60 years and above were most concerned about possible damage to wrist structures; younger respondents were most concerned that transverse scars appeared like self-inflicted injuries. CONCLUSION Respondents from the general public preferred a longitudinal scar to a transverse one. Younger respondents were most concerned about how the transverse scar appeared like a self-inflicted injury while older respondents were most concerned with perceived functional implications of the incisions.
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Affiliation(s)
| | | | - Mala Satku
- Hand and Microsurgery Section, Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - Sreedharan Sechachalam
- Hand and Microsurgery Section, Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - Chong Jin Yeo
- Hand Surgery Associates, Mount Elizabeth Novena Specialist Centre, Singapore
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Naito K, Sugiyama Y, Kinoshita M, Obata H, Goto K, Nagura N, Iwase Y, Obayashi O, Kaneko K. Functional Outcomes in Volar-Displaced Distal Radius Fractures Patients with Marginal Rim Fragment Treated by Volar Distal Locking Plates. J Hand Microsurg 2018; 11:100-105. [PMID: 31413494 DOI: 10.1055/s-0038-1675245] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 08/10/2018] [Indexed: 10/27/2022] Open
Abstract
Background Treatment of volar-displaced distal radius fractures (DRF) accompanied by marginal rim fragment has recently been actively discussed. It is difficult to obtain a sufficient buttress effect on this fragment. Therefore, we actively apply a distal volar locking plate (DVLP) to fractures with this fragment. Here, we report the treatment outcomes and caveats of surgery of fractures with this fragment. Materials and Methods The subjects were 32 patients (male: 11, female: 21, and mean age: 59.4 years) with volar dislocated DRF accompanied by the marginal rim fragment treated using DVLP. The fracture type of AO classification was B3 in 6 patients, C1 in 12, C2 in 6, and C3 in 8. Results The mean duration of follow-up was 13.8 (12-30) months. The plate could be covered with the pronator quadratus muscle in surgery in all patients. On the final follow-up, visual analog scale score was 1.4/10, quick disabilities of the arm, shoulder, and hand score was 9.2/100, and the Mayo wrist score was 93.7/100. No complication was observed in the soft tissue, such as the nerves and flexor tendons. Conclusion The factor determining retention of the reduction position of the marginal rim fragment is a sufficient buttress effect, and DVLP is a useful implant in terms of this point.
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Affiliation(s)
- Kiyohito Naito
- Department of Orthopaedics, Juntendo University School of Medicine, Tokyo, Japan
| | - Yoichi Sugiyama
- Department of Orthopaedics, Juntendo University School of Medicine, Tokyo, Japan
| | - Mayuko Kinoshita
- Department of Orthopaedics, Juntendo University School of Medicine, Tokyo, Japan.,Department of Orthopaedic Surgery, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Hiroyuki Obata
- Department of Orthopaedics, Juntendo University School of Medicine, Tokyo, Japan
| | - Kenji Goto
- Department of Orthopaedics, Juntendo University School of Medicine, Tokyo, Japan
| | - Nana Nagura
- Department of Orthopaedics, Juntendo University School of Medicine, Tokyo, Japan.,Department of Orthopaedic Surgery, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | - Yoshiyuki Iwase
- Department of Orthopaedic Surgery, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | - Osamu Obayashi
- Department of Orthopaedic Surgery, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Kazuo Kaneko
- Department of Orthopaedics, Juntendo University School of Medicine, Tokyo, Japan
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11
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Hu ZJ, Li M, Liu X, Liu CK. Palmar approach with Kirschner-wire fixation in the treatment of children's distal radius extension type fracture. Chin J Traumatol 2018; 21:301-303. [PMID: 30340978 PMCID: PMC6235786 DOI: 10.1016/j.cjtee.2018.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 08/29/2018] [Accepted: 09/02/2018] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To explore the advantages of palmar approach with Kirschner-wire (K-wire) fixation in the treatment of children's distal radius extension type fracture. METHODS Thirty patients, average age of 8.5 years ranging from 5 to 13 years, with distal radius extension type fracture and undergoing a failed manual reposition in our hospital were included, and treated by palmar approach with K-wire fixation between May 2014 and December 2017. Among these patients (21 male and 9 female), 5 patients had chronic injuries over 10 days, and 6 patients had fracture of the distal radius epiphysis. The time between injury and treatment ranged from 1 to 30 days. Among them, 11 patients with right-sided fractures and 19 patients with left-sided fractures were operated via the palmar longitudinal incision approach. RESULTS The results were evaluated after an average of 18 months ranging from 5 to 36 months after operation. The recovery time of fracture was from 4 to 8 weeks and all incisions were primary healing with an average of 6 weeks. Nonunion, delayed union, early closure of distal radial epiphysis, and wrist varus/valgus deformity were not found in all the cases. Based on Gartland and Wereley wrist score assessment undertaken three months after operation, excellent scores were achieved in 24 cases, good scores in 3 cases, acceptable scores in 3 cases. CONCLUSION The palmar approach with K-wire fixation via a front longitudinal incision in the treatment of children's distal radius extension type fracture has following advantages: (1) easy to reposition for both fresh and old fractures; (2) less damage to surrounding tissues and epiphysis; (3) quick recovery. It is suitable to treat children's distal radius extension type fracture.
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12
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Minimally Invasive Plate Osteosynthesis for a Distal Radius Fracture with Forearm Skin Problem. Case Rep Orthop 2018; 2018:8195376. [PMID: 30034900 PMCID: PMC6035807 DOI: 10.1155/2018/8195376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 06/12/2018] [Indexed: 11/30/2022] Open
Abstract
In this study, we performed osteosynthesis for a distal radius fracture using a minimally invasive approach for a patient with skin disorder of the forearm and obtained favorable results. This case report may provide new findings confirming the usefulness of this surgical approach for distal radius fractures. Blister formation on the right forearm was observed in a 53-year-old female who was diagnosed with a distal fracture of the right radius and underwent splinting in a local hospital, and she was referred to our hospital 2 days after the injury. Minimally invasive locking plate osteosynthesis was performed, and there was no skin lesion at this incision site. Postoperatively, there were no complications in soft tissues and the operative scar was almost unrecognizable. We reported volar locking plate osteosynthesis using the minimally invasive approach in a patient with skin disorder of the forearm. Such patients are rarely encountered. However, this minimally invasive approach is extremely useful for utilizing the advantages of volar locking plate fixation without being affected by the soft tissue environment.
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13
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Zemirline A, Taleb C, Naito K, Vernet P, Liverneaux P, Lebailly F. Distal radius fracture fixation with a volar locking plate and endoscopic carpal tunnel release using a single 15mm approach: Feasibility study. HAND SURGERY & REHABILITATION 2018; 37:S2468-1229(18)30068-9. [PMID: 29779839 DOI: 10.1016/j.hansur.2018.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 03/09/2018] [Accepted: 03/13/2018] [Indexed: 12/31/2022]
Abstract
Distal radius fractures (DRF) may trigger, reveal or decompensate acute carpal tunnel syndrome (CTS) in 0.5-21% of cases. Internal fixation and median nerve release must then be carried out urgently. Less invasive approaches have been described for both the median nerve release using an endoscopic device and for the DRF fixation using a volar locking plate. We assessed the feasibility of DRF fixation and median nerve release through a single, minimally-invasive 15mm approach on a series of 10 cases. We reviewed retrospectively 10 consecutive cases of DRF associated with symptomatic CTS in 8 women and 2 men, aged 57 years on average. CTS was diagnosed clinically. All patients were treated during outpatient surgery with a volar locking plate and endoscopic carpal tunnel release using a single 15mm minimally-invasive approach. In one case, arthroscopic scapholunate repair was also required. Six months after the procedure, all patients were reviewed with a clinical examination and a radiological evaluation. The average values for the clinical and radiological outcomes were as follows: pain on VAS 1.5/10; QuickDASH 14.3/100; flexion 90%; extension 90.6%; pronation 95.6%; supination 87.9%; grip strength 90.1%; 2PD test 5.2mm (4-8mm). Five complications occurred: two cases of temporary dysesthesia in the territory of the median nerve and one case of temporary hypoesthesia of the palmar branch of the median nerve, which had all completely recovered; two cases of complex regional pain syndrome type I, which were still active at 6 months. Despite its methodological weaknesses, our study is the only one to describe the technical feasibility of a single 15mm minimally-invasive approach for both internal fixation using a volar locking plate and endoscopic nerve release, with no serious complications. This technique should be added to the surgical toolbox of minimally-invasive procedures for the hand and wrist.
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Affiliation(s)
- A Zemirline
- Hand Center of Brittany, Saint-Grégoire Private Hospital Center, 6, boulevard de la Boutière, 35760 Saint-Grégoire, France.
| | - C Taleb
- Department of Orthopaedic Surgery, Mulhouse Hospital Center, 20, avenue Docteur René-Laennec, 68100 Mulhouse, France
| | - K Naito
- Department of Orthopaedics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, 113-8421 Tokyo, Japan
| | - P Vernet
- Department of Hand Surgery, Strasbourg University Hospital, 10, avenue Achille-Baumann, 67400 Illkirch, France
| | - P Liverneaux
- Department of Hand Surgery, Strasbourg University Hospital, 10, avenue Achille-Baumann, 67400 Illkirch, France
| | - F Lebailly
- Clinique Saint-Paul, 3, rue des Hibiscus, 97200 Fort-De-France, France
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14
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Lucke-Wold BP, Bonasso PC, Jacob G. Re-fracture of Distal Radius and Hardware Repair in the Setting of Trauma. MEDICAL STUDENT RESEARCH JOURNAL 2018. [PMID: 29520327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/28/2022]
Abstract
Distal radius fractures are one of the most common fractures in the elderly. Falls and motor vehicle collisions lead to increased risk for this type of fracture. A seventy-three year-old female had a previous history of distal radius fracture with repair by open reduction and internal fixation. She was involved in a motor vehicle collision that re-fractured the distal radius. The plate was bent and required removal, which is a very rare but potentially serious complication. Surgery was done to fix the open reduction and internal fixation with volar locking plates while removing damaged hardware. Only a select few cases have reported hardware failure as a cause of complications. Among those cases, high-energy activities and maintained stress on the hardware were likely causes. Distal radius fractures are the most common upper extremity fracture in the elderly. We highlight a unique case of re-fracture in the setting of trauma with prior hardware failure and describe the strategy for hardware repair.
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Affiliation(s)
| | | | - Glen Jacob
- Department of Surgery, West Virginia University School of Medicine
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15
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Abstract
This article reviews the author's currently used minimal invasive approach for volar plating of distal radius fractures. A single longitudinal incision of 1.5 cm is drawn on the lateral aspect of the flexor carpi radialis tendon in order to insert a plate under the pronator quadratus. With the wrist flexed, the plate is applied on the anterior cortex of the radius to reduce the fracture. This approach offers the advantage of preserving ligamentotaxis, which facilitates the reduction, and the small scar improves the cosmetics. It is mainly indicated for extra-articular and simple intra-articular fractures of the distal radius. Relative contraindications are comminuted articular fractures in elderly osteoporotic patients. Functional and radiological results are comparable with those obtained with an extended flexor carpi radialis approach. My colleagues and I have used it for more than 2000 cases since 2012. This technique requires practise. Attempted conversion to a larger incision is possible in case of difficulty, but this is seldom necessary.
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16
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Igeta Y, Vernet P, Facca S, Naroura I, Hidalgo Diaz JJ, Diaz JJH, Liverneaux PA. The minimally invasive flexor carpi radialis approach: a new perspective for distal radius fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:1515-1522. [PMID: 29368237 DOI: 10.1007/s00590-018-2124-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 01/08/2018] [Indexed: 11/25/2022]
Abstract
The minimally invasive flexor carpi radialis approach can be used for volar locking plate fixation of distal radius fractures. After 15-mm incision on the lateral aspect of the FCR tendon and all structures but the radial artery are reclined ulnarly, a plate is inserted under the pronator quadratus just proximal to the "watershed line." The distal epiphyseal screws are put in place, and the proximal part of the plate is exposed by flexion of the wrist to put in place the proximal screws. No drainage or postoperative immobilization is used. It offers the advantage of preserving ligamentotaxis which facilitates the reduction, and the small size of the scar improves the esthetic result of the procedure. It is indicated for extra-articular fractures of the distal radius. In the case of an intraarticular fracture, an arthroscopy may be associated. In the case of a proximal diaphyseal extension of the fracture, a second proximal approach can be added in order to use a longer plate. Relative contraindications are comminuted articular fractures in elderly osteoporotic patients. Functional and radiological results are comparable to those obtained with the extented flexor carpi radialis approach. A conversion of the procedure for a larger incision is always possible in the case of a difficult reduction.
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Affiliation(s)
- Yuka Igeta
- Icube CNRS 7357, Department of Hand Surgery, SOS Main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, 10 Avenue Baumann, 67400, Illkirch, France.,Department of Orthopedic Surgery, Juntendo University, Tokyo, Japan
| | - Paul Vernet
- Icube CNRS 7357, Department of Hand Surgery, SOS Main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, 10 Avenue Baumann, 67400, Illkirch, France
| | - Sybille Facca
- Icube CNRS 7357, Department of Hand Surgery, SOS Main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, 10 Avenue Baumann, 67400, Illkirch, France
| | - Ismaël Naroura
- Icube CNRS 7357, Department of Hand Surgery, SOS Main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, 10 Avenue Baumann, 67400, Illkirch, France
| | | | - Juan José Hidalgo Diaz
- Icube CNRS 7357, Department of Hand Surgery, SOS Main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, 10 Avenue Baumann, 67400, Illkirch, France
| | - Philippe A Liverneaux
- Icube CNRS 7357, Department of Hand Surgery, SOS Main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, 10 Avenue Baumann, 67400, Illkirch, France.
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